Music Therapy and Mental Health Mental Health Care and Bimaristans in the Medical History of Islamic Societies

Rüdiger Lohlker (Vienna University) Music Therapy and Mental Health Mental Health Care and Bimaristans in the Medical History of Islamic Societies Even recent studies on the histories of hospitals only have few pages on Islamic hospitals.1 Thus, it is necessary to turn to a thorough study of Islamic hospitals as an important element of a global history of hospitals and health care. There are other names for hospitals in Islamic times, but this study will use the term bīmāristān to identify these institutions. Our focus will be on mental health and bīmāristāns another field still underresearched.2 Recent studies claim that going beyond the classical studies of ideas of medicine and leaving the old paradigms of Islamic exceptionalism behind, would allow for an integration of the study of medicine in Islamic societies into the field of science studies3 and for a better understanding of the institutional contexts of medical practice.4 Understanding the history of Islamic hospitals means turning to pre-Islamic times.5 We could turn to pre-Islamic Arabia6, but more important may be the Eastern part of what was to be the Islamic world. Thus, we will be able to look into the institutional contexts of Islamic medicine7 – and especially its aspects related to mental health.8 1 In numbers: four pages, thus, excluding Islamic institutions from a general history of hospitals (Risse 1999). 2 Thanks to Margareta Wetchy for her valuable comments. Thanks also to the organizers from the Austrian Academy of Sciences of the Maimonides Lectures 2019 in the Austrian city of Krems who gave the opportunity to present a first version of these ideas. Many thanks to Salim al-Hassani for inspiring some modifications of my argument. 3 Brömer 2010 and Northrup 2013. cf. Gran 1998, pp. 165Sqq. for a – seldom referred to – first attempt of an advanced analysis of medical literature. 4 For the time being we are lacking a reconstruction of the perspective of patients. 5 For a recent conceptualization of this period see Al-Azmeh 2014a and Al-Azmeh 2014b. 6 Female physicians and healers are well known in pre-Islamic times in Arabia (Shehata 2007-2008: 10-11). A thorough history of female physicians in Islamic healthcare is still missing. For male physicians in pre-Islamic times we would have to turn to the chapter on the Classes of Physicians in the time of the rise of Islam in Ibn Abī Uṣaybiʿa‘s famous history of physicians. However, there is some legendary material in it (Ibn Abī Uṣaybiʿa 1965 and Ibn Abi Usaibia 2020). 7 For an overview see Savage-Smith 2007. Older, but including more aspects see Ullmann 1997. For one treatise from Egypt see Dols/Gamal 1984. A highly valuable volume with many interesting chapters is Pormann 2011. 8 Mental health may be contextualized in recent discussions on „bodily experience“ (körperliche Erkenntnis) to inscribe into broader phislosophical discussions; see the contributions in Bockrath/Boschert/Franke 2008. For a recent overview of research on mental health and religion see Classen 2014. On the History of bīmāristāns A historical view will have to start from the assumption that there have been pre-Islamic precursors to the bīmāristān. These hospitals are not a genuine Islamic invention. The most important pre- Islamic hospital may be the Gundishapur hospital of Iranian and Syriac origin.9 Older research and research based on the older research literature claims: „Without doubt it is on Hārūn al-Rashīd (170/786-193/809) that the merit falls for having founded the first hospital to have functioned in the Islamic world.“10 But there is another (hi)story to be told. As Michael W. Dols and others wrote, the conventional history of bīmāristāns „bristles with difficulties“.11 This is not the place to follow the detailed argumentation of Dols on the pre-history of the bīmāristān and, esp., the Syriac influence. Dols sets the date for the foundation of the first Islamic hospital „in the first decade of the ninth century A. D.“12 Another question arising from earlier research is whether it would be adequate to say Gundishapur should be regarded as a „provincial backwater“.13 There are indeed indications that Gundishapur may have played a certain role in the history of medicine.14 Even accepting that Gundishapur was not as important as some researchers15 want it to be, we may interpret the historical discussions about the historical importance of institutions as part of intra-professional discussions about giving precedence to adherents of Graeco-Arabic traditions, Syro-Arabic traditions, Iranian or even Indian traditions.16 Thus, Gundishapur may be understood as a stake in symbolic games by Syriac physicians and not discussed in terms of historical truth.17 This argument may be supported if we read: „The kings of the Persians (ʿajam) used to divert the melancholic (maḥzūn) by listening to music (samāʿ), to distract the sick (marīḍ) and to keep him away from negative thoughts.“18 Thus, even the assumption of the existence of an ancient tradition of music therapy (see below) in Iran may lead us to understand Gundishapur as a prime symbol of the mythology19 of medical 9 See for later hospitals in Iran often called dār al-shifāʾ Tadjbakhsh 2012 and Floor 2012. 10 Micheau 1996: 991. 11 Dols 1987: 369. 12 Dols 1987: 382. 13 Vivian Nutton quoted in Nayernouri 2017. 14 Following Nayernouri 2017. See, esp., Shahbazi/Richter-Bernburg 2012. 15 Some of them even misquoting other research literature. See Miller 2006 quoting Dols 1987 (leaving aside some other mistakes included as to numbers, etc.). 16 The Indian influence on Persian medicine in Islamic times has been analyzed by Speziale 2018. 17 Thus, it may interesting to follow the idea of Tabaa reading the Abbasid support for hospitals as an attempt to „outshine the glory of the Sassanian kings“ (Tabaa : 98) and to claim the heritage of the previous dynasty by contructing a genealogy back to Gundishapur. 18 al-Jāḥiẓ 1965: 286. 19 Evidently, I am referring to the excellent chapter of Ragab 2018: 140. expertise. A passage from a literary work illustrates how much physicians from Gundishapur are imagined to be searched for.20 And it will indicate how intercommunal tensions amongst practitioners worked: „He [sc. Asad ibn Ǧānī] was a physician. Once business was slow, so someone said to him: „It is a plague year, disease rampant everywhere, and you are a knowledgeable man with steadfastness, experience, and clear understanding. How does it come about that you have this dearth [of patients]?“ To which he replied: „For one thing, people know me to be a Muslim, and have held the belief, even before I began to practice medicine, no indeed before I was born, that Muslims are not successful in medicine. Then, my name is Asad, when it ought to have been Ṣalīb, Ǧibrāʾīl, Yuḥannā, and Bīrā [i. e., Christian or Jewish names]. My surname is Abū l-Ḥāriṯ, but it ought to have been Abū ʿĪsā, Abū Zakarīya, and Abū Ibrāhīm [i. e., Christian or Jewish surnames]. I wear a shoulder mantle of white cotton, yet my shoulder mantle ought to be of black silk. My pronunciation is that of an Arab, when my dialect ought to be that of the people of Ǧundaisābūr [i. e., Christian physicians].“21 Why the death of the last leading physician of the bīmāristān of Gundishapur, Sābūr ibn Sahl (d. 869)22 who moved from Gundishapur to Baghdad to join the circle of medical advisers to the then Abbasid caliph meant the death of the institution is not clear.23 What is the origin of the name of the institution? It can be derived from the Persian for sick, bīmār, and the suffix, -stān, denoting place; the short form is māristān. For a sketch of the role of the bīmāristān we will turn to the description of Savage-Smith: „The Islamic hospital served several purposes: a centre for medical treatment, a convalescent home for those recovering from illness or accidents, an insane asylum and a retirement home giving basic maintenance needs for the aged and infirm who lacked a family to care for them. In the first two instances, admission would be for a limited period of time, with the view of curing a particular disorder. In the last category, it is unclear how many, if any, were of the truly indigent and uneducated classes. […] It is most unlikely that any true wealthy person would have gone to a hospital for any purpose, unless they were taken ill while travelling far from home. Except under very unusual circumstances all the medical needs of the wealthy and powerful would have been 20 There would be an interesting history to tell about the distinctions between professional physicians and charlatans. We cannot tell it here, see for this aspect of medical history Pormann 2005. 21 Pormann 2005: 221. The translation from Jahiz‘ Kitab al-Bukhala‘ by Serjeant has been slightly adopted by Pormann; cf. Taylor 2010: 1 and Dols 1987: 381sq. for the context of the story in Jahiz‘ book. 22 See for him Kahl 2009. Cf. Lev/Chipman 2007. 23 Shabazi/Richter-Bernburg 2012. administered in the home or through outpatient clinics dispensing drugs. […] The care for the insane in hospitals was unprecedented and an important part of even the earliest Islamic hospitals.“24 We cannot give a narrative of the history of the bīmāristān as an institution here.25 We may mention just one important type of bīmāristāns, the bīmāristāns for the care for mentally affected patients. This may have been an important function of these hospitals. Frequently in big bīmāristāns there were special places isolated by iron bars for aggressive patients protecting other patients and visitors from them (see below).

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